Surgery for primary hyperparathyroidism 1962-1996: Indications and outcomes
ABSTRACT To examine changes over the past three decades in the indications for, and outcomes of, surgery for primary hyperparathyroidism.
Survey of a prospective hospital database.
Royal North Shore Hospital (a tertiary referral and university teaching hospital), Sydney, New South Wales, January 1962 to December 1996.
All 733 patients who underwent neck exploration for primary hyperparathyroidism.
The annual number of parathyroidectomies increased virtually exponentially, from a mean of two in 1962-1969 to 73 in 1996. In the 1960s and 1970s, the most common indication for surgery was the presence of renal calculi (58% and 43%, respectively), but in the 1980s there was a marked increase in presentation of asymptomatic disease after biochemical screening (19%). In the 1990s, low bone mineral density detected by osteodensitometry has become the most common indication for surgery (31%). After initial operation, 11 patients (2%) had persistent hypercalcaemia, with five of these cured by reoperation--an overall failure rate of 1%.
Surgery for primary hyperparathyroidism has become increasingly common, with low bone mineral density replacing renal calculi as the most common indication for surgery. Neck exploration in experienced hands results in an overall cure rate of 99%.
- SourceAvailable from: Matthieu Pelletier-Galarneau
[Show abstract] [Hide abstract]
- "Primary hyperparathyroidism is among the most common endocrine disorders with a prevalence reaching 0.1% to 0.4%  . Diagnosis of primary hyperparathyroidism is based on biochemical markers, including serum parathyroid hormone (PTH) and serum calcium  . "
ABSTRACT: With dual-radiopharmaceutical (DR) parathyroid scintigraphy, imaging with 99m TcO 4-or 123 I-NaI is combined with 99m Tc-sestamibi scintigraphy for localization of parathyroid adenomas. The set images are then either visually compared or digitally subtracted to aid in interpretation. While both EANM and SNMMI guidelines recommend use of digital subtraction over visual interpretation alone, to date, the few formal comparisons performed have not demonstrated superiority. The purpose of this investigation is to rigorously assess the added value of digital subtraction over visual interpretation alone using simultaneously-acquired 123 I-NaI and 99m Tc-sestamibi images. Materials: 90 consecutive patients with DR parathyroid scintigraphy for primary hyperparathy-roidism who underwent successful parathyroidectomy were included. DR planar acquisition was performed 15 minutes post injection using 10% dual energy windows. Digital subtraction was subsequently performed using commercially available software. Images were independently reviewed by 3 nuclear medicine trainees and 2 experienced nuclear medicine physicians with and without digital subtraction. Results were compared with surgical and histopathologic findings, which served as ground truth. Results: 90 patients had a total of 91 confirmed parathyroid lesions. All 5 readers had significantly greater sensitivity with digital subtraction compared with visual interpretation alone while specificity was not significantly diminished. Area under the ROC curve was significantly greater with digital subtraction in 3 of 5 readers. Agreement was greater among trainees and experienced physicians when using digital subtraction. Conclusion: Using an optimized DR planar co-imaging technique, digital subtraction significantly improved inter-observer agreement and confidence of interpretation and increased sensitivity, without diminishing specificity.Open Journal of Medical Imaging 07/2015; 5(02):42-48. DOI:10.4236/ojmi.2015.52007
- "Tc-pertechnetate subtraction scintigraphy; CT, CT scan of the neck and mediastinum; TP, true positive; FN, false negative. overall cure rate greater than 90% (Arnaud 1994, Shen et al. 1997, Roe et al. 1998, Delbridge et al. 1998). However, most studies suggested that preoperative localization of abnormal parathyroid glands may be useful in reducing operative time, morbidity and hospital stay, facilitating parathyroidectomy especially in patients with ectopic parathyroid tumours (Wei & Burke 1995, Sfakianakis et al. 1996, Gupta et al. 1998, Sofferman & Nathan 1998, Vogel et al. 1998, Boggs et al. 1999, Chen et al. 1999, Lumachi et al. 1999, Song et al. 1999). "
Dataset: 2001 ERC 63 HPT
[Show abstract] [Hide abstract]
- "The usual treatment is surgical removal of the parathyroid glands with follow-up drug treatment (Ball, 1996). Delbridge et al. (1998) reports a 99% cure rate for surgery though recurrences still present a significant challenge. As with phaeochromocytoma, genetic screening for HPT in MEN2A is unlikely to have significant implications for insurance on its own, due to its low penetrance, mild nature and the availablility of effective treatment. "
ABSTRACT: We survey the relevant literature on Multiple Endocrine Neoplasia Type 2 (MEN2), an inherited form of cancers of the endocrine system that is one of the seven disorders listed as being potentially significant for insurance by the Association of British Insurers (ABI). Unlike some other disorders on the ABI's list, genetic screening of members of at-risk families is cheap and becoming widely available, and early surgical intervention is both tolerable and effective. The advent of genetic testing ought therefore to be wholly beneficial, and this should neutralise the risk MEN2 presents to life and critical illness insurers, even to the extent of reducing or removing the risk that was presented by a family history of MEN2 before genetic screening was possible. We suggest that the priority for the insurance industry is to ensure that underwriting practices do not deter persons at risk of MEN2 from undergoing screening.